Provider Demographics
NPI:1487718391
Name:SANTIAGO, JOSE W (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:W
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5209
Mailing Address - Country:US
Mailing Address - Phone:724-983-5454
Mailing Address - Fax:724-983-5914
Practice Address - Street 1:2375 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-983-5454
Practice Address - Fax:724-983-5914
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039528 E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0489834OtherAETNA
MI251638612OtherDPW
251638612OtherMEDICAL MUT PPO
PAE52896OtherHEALTH AMERICA
000000115000OtherONE NATION BENEFIT ADMIN
PAE52896OtherHEALTH ASSURANCE
MI25163861200OtherCIGNA
PA0011099910001OtherDPW
OH0789384OtherDPW
PA552127OtherBCBS PA PPO POS HMO TRAD
PA001109991Medicaid
157858000OtherMAGELLAN BEHAVIORAL
552127OtherKHPW HMO
VA058022OtherVALUE OPTIONS
201548OtherUPMC POS HMO
PAE52896OtherHEALTH AMERICA
MI251638612OtherDPW
552127OtherKHPW HMO
260012699Medicare ID - Type UnspecifiedRAILROAD